Dr Amit Arora is a consultant geriatrician at the University Hospital of North Midlands and has served as Chairman of England Council of the British Geriatrics Society. He and his team have developed the campaign “Sit up, Get Dressed, Keep Moving” which is being adopted in many NHS hospitals and abroad.
In David Mitchell’s recent article “‘Get Out of Bed!’ scheme is more symptom than solution for the NHS” which was published on the Guardian website he appreciates the simplicity and value of the campaign but questions whether the campaign is financially motivated.
I congratulate and thank Mitchell for raising awareness about benefits of early functional normalisation: “The Principle that people who have been hospitalized should re-start normal life as soon as they can is already well established”. He further writes that “it’s suspicious that a campaign exclusively pushing the idea of getting up and going home should coincide so precisely with the NHS’s dire shortage of money.” I would like to detail how the campaign started and how it is free from any ‘spin’.
Richard Asher described the effects of inappropriate bed rest it in his landmark article in the BMJ (1947), ‘The dangers of bed rest’. He said, “Teach us to live that we may dread, unnecessary time in bed; Get people up and we may save, Our patients from an early grave.”
Along with some of my staff, I conceived the idea and started indigenous work on the campaign ‘Sit up, Get Dressed, Keep Moving’ in April 2016 with a wider roll out in October 2016. However the roots of these go back to many years of personal observation and related remedial work when I wanted activity coordinator staff to improve functional activity on wards. The next step was to reconfigure existing resources to achieve maximum benefit. The campaign was initiated with some nurses and therapists on a small scale and relied on staff motivation, contribution and goodwill. It became successful as the staff knew in their heart that this was the right thing to do, something they should be doing but somehow it was not always done.
With support from the British Geriatrics Society and NHS England; within a month there were requests for our material from clinical staff from over 20 hospitals, including from Australia, New Zealand and Canada – and more and more have joined in over the last few months. The campaign also got unprecedented support from ECIST (Emergency Care Intensive Support Team) #endpjparalysis campaign and Jane Cummings (Chief Nurse NHS England) and the efforts to prevent deconditioning became popular.
The fact that almost all of the requests for our material were directly from clinicians lends credence to the fact that this campaign is entirely driven by clinical staff and close to their experiences of functional decline in their loved ones during hospital admissions. In fact many staff I met have detailed such stories and I am sure readers will know of similar stories.
Mitchell rightly asks, if it is so obvious that if this is the right thing to do, why does it need to be publicised? The fact is that patients in hospital beds do not always receive the encouragement to ‘Sit up, Get Dressed, Keep moving’ as staff are ‘too busy’. It has been repetitively thought of as ‘not my responsibility’, whereas it should be everyone’s responsibility be it the consultant, nurses, therapists, porters, dinner ladies or other staff. To encourage exercise and routine activity of daily living is an extremely important factor in recovery but somewhere down the line this has been forgotten.
Older people, the core users of NHS, benefit most from this campaign. This is because during hospitalization older people can spend up to 83% of their time sitting in bed and often a further 12% in a chair. Patients therefore become deconditioned with deconditioning starting from as early as with in first 24 hours when patients could lose up to 2-5% of their muscle mass. It is often said that ten days of bed rest can lead to up to ten years equivalent of muscle ageing in people over the age of 80 years. Muscle ageing results in poorer outcomes. Reconditioning can often take twice as long. Up to 65% of older people can experience decline in function during hospitalization. Many patients may not improve fully; for some ‘Sit up, Get Dressed, Keep Moving’ could be the difference between going home and going into a home!
Deconditioning risk can be minimized by raising awareness and proactively preventing deconditioning, and that’s what the campaign aims to do.
The campaign was conceived and developed by clinicians, without any policy, budget or perverse incentives. It is one of those fabulous things that NHS staff developed and delivered themselves with minimal resources. This is the time to celebrate and promote this campaign and make it part of our routine clinical practice to achieve better patient outcomes.